Diagnosis of Vesicoureteral Reflux: Voiding Cystourethrography and Pediatric Evaluation of Recurrent UTIs

Hispanic pediatrician consulting with a child, explaining the urinary system using a diagram. In the background, an anatomical poster of the urinary system. The setting is a modern pediatric examination room, emphasizing the importance of pediatric evaluation in diagnosing vesicoureteral reflux and recurrent UTIs through voiding cystourethrography.

Vesicoureteral reflux (VUR) is a common congenital anomaly of the urinary tract characterized by the retrograde flow of urine from the bladder into the upper urinary tract. This phenomenon can predispose patients, particularly children, to recurrent urinary tract infections (UTIs) and long-term renal damage. Voiding cystourethrography (VCUG) is considered the gold standard for the diagnosis of VUR, providing detailed images of the urethra and bladder during bladder filling and emptying, as well as the ureters and kidneys when reflux is present.

Delving into the Diagnosis of Vesicoureteral Reflux

The diagnosis of VUR has been a topic of debate over the last decade, particularly regarding which patients should be evaluated and when intervention should occur. Some experts consider VUR to be a "phenotype" that often resolves without intervention, while others warn that untreated reflux can lead to irreversible renal damage over time. VCUG remains the most widely used technique, but other imaging modalities, such as contrast-enhanced voiding urosonography (ceVUS), have been explored as a radiation-free alternative [1].

Additionally, direct radionuclide cystography (DRC) has been used for over half a century, primarily in children, to reduce radiation exposure [2]. However, its effectiveness as a detection tool has been questioned due to the frequent need for a complementary VCUG [3].

Regarding urinary symptoms, children with VUR may present with recurrent UTIs, which are an important clinical sign to consider for evaluation with VCUG. Early identification and appropriate management of VUR can prevent pyelonephritis and renal scarring, underscoring the importance of accurate and timely diagnosis [4].

Conclusions

The diagnosis of vesicoureteral reflux is a complex process that requires careful evaluation of urinary symptoms and the use of appropriate imaging techniques. VCUG remains the reference method, but alternatives such as ceVUS and DRC offer additional options, particularly in terms of reducing radiation exposure. Early identification and management of VUR are crucial to preventing long-term complications, such as renal damage. The choice of imaging modality should be based on an individualized assessment of risk and parental preferences, always considering the most recent evidence and current clinical guidelines.

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Created 6/1/2025